Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Neurogastroenterol Motil. 2018 Mar;30(3). doi: 10.1111/nmo.13219. Epub 2017 Sep 22.
Intestinal manometry is the current standard for direct evaluation of small bowel dysmotility. Patients with abnormal motility can either be diagnosed of pseudo-obstruction when there are radiological findings mimicking mechanical intestinal obstruction or of enteric dysmotility when these findings are absent. The aim of the present study was to prospectively compare small bowel manometric abnormalities with histopathological findings in intestinal full-thickness biopsies in patients with severe dysmotility disorders.
We investigated 38 patients with intestinal manometry and a subsequent full-thickness intestinal biopsy. Manometric recordings were read by 4 investigators and a diagnostic consensus was obtained in 35 patients. Histopathological analysis, including specific immunohistochemical techniques of small bowel biopsies was performed and compared to manometric readings.
Patients with abnormal intestinal manometry had abnormal histopathological findings in 73% of cases. However, manometric patterns did not match with the specific neuromuscular abnormalities. Among patients with a neuropathic manometry pattern and abnormal histopathology, only 23% had an enteric neuropathy, whereas 62% had neuromuscular inflammation, and 15% an enteric myopathy. On the other hand, patients with a myopathic manometry pattern all had abnormal histopathology, however, none of them with signs of enteric myopathy.
CONCLUSION & INFERENCES: Small bowel dysmotility detected by intestinal manometry is often associated with abnormal neuromuscular findings in full-thickness biopsies. However, there is no correlation between the specific manometric patterns and the histopathological findings.
肠道测压是目前直接评估小肠运动障碍的标准方法。当存在影像学表现类似于机械性肠梗阻的运动障碍时，患者可以被诊断为假性肠梗阻；当不存在这些影像学表现时，患者可以被诊断为肠动力障碍。本研究的目的是前瞻性比较小肠测压异常与严重运动障碍患者的全层肠道活检的组织病理学发现。
我们研究了 38 例进行肠道测压和随后的全层肠道活检的患者。4 位研究者对测压记录进行了阅读，并在 35 例患者中获得了诊断共识。对小肠活检进行了组织病理学分析，包括特定的免疫组织化学技术，并与测压结果进行了比较。
异常肠道测压的患者中有 73%的患者存在异常的组织病理学发现。然而，测压模式与特定的神经肌肉异常不匹配。在具有神经病变测压模式和异常组织病理学的患者中，仅有 23%存在肠神经病变，而 62%存在神经肌肉炎症，15%存在肠肌病。另一方面，具有肌病性测压模式的患者均存在异常的组织病理学，但均无肠肌病的迹象。
肠道测压检测到的小肠运动障碍常与全层活检中的异常神经肌肉发现相关。然而，特定的测压模式与组织病理学发现之间没有相关性。
